APEC 611

Scientific and Industrial

Instrumentation
Electrocardiogram (ECG)
Where Is Your Heart?
 Is Your Heart Beating?

It is not the origin of emotion rather origin of

circulation
Pumps blood
75 times/min
Basic Structure
4 Chambers
2 Upper Chambers
Right & Left Atria
2 Lower Chambers
Right & Left Ventricle
4 Valves
2 Atrioventricular
2 Semilunar
How Does It Look Like?
The Conduction System of Heart

SA Node
Sinus or
SinoatrialNode
Inter-nodal
pathway
AV Node
Atrioventricular
node
Bundle of HIS
Bundle
Impulse Conduction

SA Node
AV Node
Bundle of His
Bundle
Branches
Purkinje fibers
Electrophysiology of the Heart
 What is an ECG?
ECG - Electrocardiogram
Representation of the
electrical events of the
cardiac cycle
Detection and amplification of
the tiny electrical changes on
the skin
Externally recorded by skin
electrodes
 Types of Leads
Coronal Plane (Limb
Leads)
Bipolar (Standard) Leads - I,
II, III
Unipolar (Augmented)
Leads aVL, aVR , aVF

Transverse Plane (Chest

Leads)
Placement of Limb Leads

Left Wrist
Right Wrist
Left Ankle
Right Ankle
Neutral lead
To complete
electrical circuit
No role in the
ECG itself
Placement of Limb Leads (Contd.)
Standard Augment
ed
 Placement of Chest Leads
V1
4th ICS, right sternal
border
V2
4th ICS, left sternal
border
V3
Midway between V2 and
V4
V4
5th ICS, left
midclavicular line
V5
Between V4 and V6, left
*ICS=Intercostal Space
 Cardiac Cycle
P Wave
Atrial depolarization
PR Interval
Impulse from atria to
ventricles
QRS Complex
Ventricular depolarization
ST Segment
Isoelectric part of
repolarisation
T Wave
Ventricular repolarisation
QT Interval
Duration of ventricular
depolarization and
 ECG Graph Paper

Graph paper
allows a visual
measurement of:
Time (rate)
Measured on the
horizontal line
Width - 1 millimeter
(mm)
Time Interval - 0.04
seconds
Amplitude
 ECG Interpretation

Five step approach

Analysis of-
Heart rate
Heart rhythm
P wave
PR interval
QRS complex
 ECG Interpretation
(Heart Rate)
The 6 second method

6 second interval on ECG strip

Strip is marked by 3 or 6 second tick marks on
the top or bottom of the graph paper
Counting number of QRS complexes within 6
second interval
Multiply the number by 10
 ECG Interpretation
(Heart Rhythm)

A sequential beating of the heart as

a result of the generation of
electrical impulses
Two Types
Regular pattern - Interval between the R
waves is regular
Intervals vary by less than 0.06 seconds or
1.5 small boxes
Irregular pattern - Interval between the
R waves is not regular
Intervals vary by greater than 0.06 seconds
 ECG Interpretation
(P Wave)

Are P waves present?

Are P waves occurring regularly?
Is there one P wave present for every QRS
complex present?
Are the P waves smooth, rounded, and upright
in appearance, or are they inverted?
Do all P waves look similar?
 ECG Interpretation
(PR Interval)

Normal interval is 0.12 0.20 seconds

Are the PR intervals greater than 0.20
seconds?
Are the PR intervals less than 0.12
seconds?
 ECG Interpretation
(QRS Complex)
Normal interval 0.06
0.12 seconds
Are the QRS
complexes greater
than 0.12 seconds (in
width)?
Are the QRS
complexes less than
0.06 seconds (in
width)?
 ECG Interpretation
(The U Wave)
Usually not visible on
ECG strips
If visible, typically
follows the T wave
Appears much
smaller than T wave,
rounded, upright, or
positive deflection if
they are present
Cause or origin is not
Thank You